Provide coordination and leadership of Medicaid programs in collaboration with the SVP of Government Programs. Medicaid programs includes State sponsored lines of business including; Medicaid, Oregon Health Plan and Healthy Kids Connect and other Children’s Health Insurance Programs (CHIP) for all states. Develop strategic business partnerships with state government as well as internal departments and leaders to ensure strong operating performance, high levels of member satisfaction, adequate provider access, compliance and audit readiness, high quality of care and sound financial performance. This position will split their time between Bend and Salem.
1. Build and maintain relationships with key departments and personnel within the State of Oregon. This includes Department of Human Services, Oregon Health Authority, Division of Medical Assistance Programs, Addictions and Mental Health, Oregon Health Policy and Research, and others.
2. Work to develop and implement managed Medicaid opportunities in other states where PacificSource does business.
3. Act as a lead participant on State level committees and workgroups overseeing and administering the Government Programs.
4. Collaborate with the Provider Network, Health Services and the Senior Vice President of Government Programs to develop and implement Health Integration initiatives. Identify, analyze, and adapt national and local access “models that work” and resources needed to develop such health care initiatives.
5. Assume a central role in working with providers, county health departments, State of Oregon, and other partners to orchestrate care model improvements for Oregon Health Plan enrollees.
6. Work closely with Government Programs Compliance Officer to ensure internal performance and policies and procedures are in alignment with state and federal legislation. Closely monitor healthcare policy and legislative developments, as well as decisions within the key agencies that impact Government Programs. Translate the impact of policy decisions to the organization; lead communication, planning and implementation efforts required for the organization to respond to policy changes in a timely manner.
7. Manage outsourced operations for Oregon Health Plan and Healthy Kids Connect; including performance monitoring, contracting, and relationship development.
8. Strategize growth opportunities for Medicaid Programs and lead implementation of product, benefit and network changes, working closely with the Operations, Provider Network, and Product Development Managers.
9. Facilitate internal multi-disciplinary committees focused on ensuring consistently strong service and operating performance within Medicaid Programs.
10. Collaborate closely with the Director of Community Development, Executive Director of Foundation regarding legislative initiatives and communication with state representatives.
11. Perform other duties as assigned.
Work Experience: Minimum of ten years experience in the health insurance industry, specifically health policy. Medicare and Managed Medicaid Programs experience required. Five years in a leadership capacity.
Language skills: Requires excellent verbal and written communication skills. Ability to read, analyze and interpret policies, documents, schedules, reports, budgets and correspondence. Ability to develop presentations and reports. Ability to effectively present information to and respond to questions from a variety of groups, including staff, management, boards of directors, employees and community stakeholders, e.g. health professionals, policymakers, foundation executives, etc.
Mathematical Skills: Requires some advanced math skills, including basic statistics and algebra; and financial analysis skills.
Reasoning Ability: Significant policy and decision-making experience, including developing and implementing management and policy best practices. Strong research, analytical, organizational and interpretative skills.
Education, Certificates, Licenses, Registration: Bachelor’s degree.
Other Skills and Abilities: Must be a versatile, business-minded individual with strong critical thinking and outstanding leadership skills. Strong consensus building and inclusive/non-consensus solution building skills; the ability to be open, direct and collegial, but also be decisive as needed. Established success in participating in a team-oriented work environment. A high degree of professional ethics and integrity; an individual who engenders and maintains trust and credibility. Well-developed complex systems thinking skills; ability to create synergy by facilitation collaboration among independent entities. Comprehensive knowledge of business principles and techniques of administration, organization and management. Health care leadership, planning and development experience with in-depth understanding of health care issues and trends. Comprehensive understanding of key issues existing in the health care industry. These include but are not limited to: federal, state, and local policies and trends in the healthcare industry.
Environment: General office environment. Local and statewide travel by automobile or air. Infrequent travel to national meetings. Requires sitting, standing, walking, and stooping / bending according to work tasks. Light lifting and carrying of files and department notebooks. Must be able to read text and numbers and communicate clearly and distinctly using a voice telephone and in person. Handles files, computer keyboard, and writing instruments.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job.
PacificSource is an equal opportunity and affirmative action employer.
PacificSource Health Plans is anything but a typical health plan. We’re a growing, independent, not-for-profit organization with a...